Provider Demographics
NPI:1184734170
Name:HARRIS, DIANE M (LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RUNNING BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5160
Mailing Address - Country:US
Mailing Address - Phone:207-653-7885
Mailing Address - Fax:207-892-2950
Practice Address - Street 1:836 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2861
Practice Address - Country:US
Practice Address - Phone:207-653-7885
Practice Address - Fax:207-892-2950
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC2976101YA0400X
MELC102081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME247560099OtherMAINECARE
ME247560099OtherMAINECARE